Basic Information
| Provider Information | |||||||||
| NPI: | 1770624181 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PROMEDICA CENTRAL PHYSICIANS | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | WESTGATE MEDICAL GROUP | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3909 WOODLEY RD | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436061169 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192912670 | ||||||||
| FaxNumber: | 4194796999 | ||||||||
| Practice Location | |||||||||
| Address1: | 3909 WOODLEY RD | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436061169 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192912670 | ||||||||
| FaxNumber: | 4194796999 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2007 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | GOVAN | ||||||||
| AuthorizedOfficialFirstName: | KIMBERLY | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PRACTICE SERVICES SUPERVISOR | ||||||||
| AuthorizedOfficialTelephone: | 4198247221 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | OH | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.